One of the hottest debates in the U.S. is over health care reform -- so-called Obamacare. Under the reform, each state would establish insurance exchanges, where consumers could shop for different health care plans. Each state has the option to set up its own exchange or let the federal government do it. - Editor.

Health industry professionals unanimously voiced support Tuesday for a state-based health insurance exchange at a meeting in Lincoln.

Gov. Dave Heineman invited more than 30 groups with a vested interest in the insurance exchange (under the so-called Obamacare health care reforms) to voice concerns and give their recommendations at meetings Tuesday and Thursday.

The meetings are part of a statewide series to create transparency in planning a health care exchange.

Heineman made it clear as he opened the meeting that he and his administration are taking steps to plan the exchange, but will not move forward until the results after the presidential election on Nov. 6.

The blueprint for the state’s exchange program is due to the federal government on Nov. 16. The Nebraska Department of Insurance has proposed that the health exchange should become a branch of its department.

Health insurance exchanges are part of the Affordable Care Act that was signed into federal law in March 2010. The law requires states to draft their own plan within the federal guidelines, or to create a joint federal-state plan or to rely on the federal government to create a plan.

On Tuesday, advocacy groups and health care providers spoke.

Kimberly Russel, president and CEO of BryanLGH Health System, proposed that some funding for the exchange could come from the state's CHIP program. This program is the Comprehensive Health Insurance Pool, which provides health insurance to Nebraskans who cannot obtain it otherwise. According to the Nebraska Health Association, the CHIP program will be phased out once the insurance exchanges are in place.

Russel, along with several other speakers, suggested using insurance premium taxes that the state receives to fund the exchange as well. It is estimated that Nebraska takes in $8 million a year in revenue from insurance premium taxes.

Scott Wooten, senior vice president and CFO for Alegent Creighton Health, agreed with the proposed state-based exchange program. He said it would be a consumer-based marketplace. Wooten suggested it would be unwise not to accept federal start-up money for the exchange, to which Heineman responded:

“They aren’t going to pay for ongoing support. When you add in costs like information technology costs, it would be around $75-$100 million a year.”

Wooten said that according to his research, projected costs would be about $17 million.

Victor Witkowicz, chairman of the Nebraska Hospital Association’s board of directors, said that the Nebraska Department of Insurance should be in charge of drafting the plan, but he believes there the governing board should be a mix between private and public to better suit the needs of all Nebraskans.

Heineman suggested that such a board could only exist in an advisory role because people are expecting elected officials to draft the exchange.

The statements and responses between the industry representatives and the governor made clear that significant controversy remains in the planning.

Heineman indicated he is not interested in drafting a healthcare exchange until after the election, in which he and other Republicans hope to see President Obama voted out of office and the subsequent repeal of the Affordable Care Act.

The Regional West Health Services, the Nebraska Chiropractic Association and the Nebraska Dental Association, among other health-related organizations, also spoke, as did social advocacy groups, including Nebraska Appleseed.

Jennifer Carter, director of the Health Care Access Program at Nebraska Appleseed, spoke in favor of a state-based exchange program, but said the group would not oppose a federal or hybrid exchange.

Carter, like Wooten, emphasized a consumer-focused market, where, she said, there is “room for consumer participation in the governance and decision-making in the exchange.”